CLINICS: Japan’s Most Popular Telemedicine System

Tomohiro Shinozaki

Business Collaboration Promotion Department
Medley, Inc.

1. Introduction
Telemedicine can be implemented using electronic
communication devices with a video call function. Medical
institutions use telemedicine in combination with face-to-facemedical care as a way of making medical care more accessible
to patients and achieving better outcomes by promoting active
patient participation. Online clinics are sometimes referred toas the fourth form of medical care alongside outpatient care,
inpatient care, and home visits.
The growth in the popularity of telemedicine in Japan differsfrom the situation in other countries. It is widely used in theUnited States, and owes its popularity to its ability to facilitate
the flexible selection of optimal treatments with an emphasis
on delivering better patient outcomes. It has been particularly
popular for key areas such as psychiatry, dermatology and primarycare, where patients often require long-term treatment.＊1 In
China, the use of telemedicine has been increasing since before
the coronavirus pandemic due to issues such as the shortage ofdoctors and lack of accessibility to medical care. For example, atelemedicine service called Ping An Good Doctor was launched byPing An Insurance in 2015, and by 2019 it had over 300 million
registered users. In Japan meanwhile, although government
restrictions on the provision of telemedicine were lifted in 2015,■ Figure 1: Overview of the CLINICS telemedicine system

only a small fraction of medical institutions have embraced it.
Although we may be lagging behind other countries, telemedicine
is starting to take off in Japan as a result of efforts to prevent thespread of coronavirus.

2. CLINICS: Japan’s most populartelemedicine system
2.1 About the CLINICS system
CLINICS is the most popular telemedicine system
in Japan.＊2 It supports a wide range of functions, including
online appointment bookings, pre-consultation checks, online
video consultations, credit card payment processing, delivery ofmedicines and prescriptions, and support for cooperation withdispensing pharmacies.
Particular features of CLINICS include:・	High usability with an emphasis on on-site operation thanks tothe participation of multiple doctors in the development of thesystem and its ongoing refinement based on actual clinical use
・	Support system for medical institutions and patient users
involving teams familiar with complicated rules and diverse
usage methods・	Compliance with guidelines and proactive approach tosecurity measures
With these features acknowledged, CLINICS has been widelyused by clinics and university hospitals throughout Japan since its
launch in February 2016. The number of medical institutions using
CLINICS passed 2,300 by the end of 2020, and by April 2021, it
had played a part in approximately 300,000 medical examinations.
2.2 Recognition and awards
CLINICS has received favorable coverage in national
newspapers including the Nihon Keizai Shimbun.
・	Selected as a top new product among about 20,000 newservices
・	Received the “Best of the Best” Award at the 2018 Nikkei
Superior Products and Services Awards, which recognizes newservices
In addition, at the 14th ASPIC IoT/AI/Cloud Awards
in 2020, we received the Ministry of Internal Affairs andCommunications award (the top award for the service receiving
the most outstanding evaluation out of approximately 70 awardwinning services) and the overall Grand Prix for the ASP/

＊1 Source: 2018 U.S. Telemedicine Industry Benchmark Survey＊2 Source: 2021 Future Prospects for New Markets in IoMT (Internet of Medical Things), Fuji Chimera Research Institute, November 2020

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SaaS category specializing in social industry. This is the second
consecutive year that we have received this award, following
the 2019 Best Social Contribution Award in the ASP/SaaS
category specializing in social industry. In FY2020, in addition
to its contribution to society, the system was comprehensively
evaluated for its rich and beneficial use record, the safety of its
services, its utility in addressing new challenges such as improving
the medical experience of patients by tying in with the family
pharmacy support system, and the active collaboration withindustry, government, and academia.

3. Examples of specific diseases for whichtelemedicine is used
Telemedicine is widely used in the departments shown in
Figure 2, especially following the outbreak of the coronavirus
pandemic.＊3 The specific diseases treated by each of thesedepartments are described below.
3.1 General internal medicine: Lifestyle-related diseases
such as diabetes
In general internal medicine, telemedicine is often used forlifestyle-related diseases such as hypertension, type 2 diabetes, anddyslipidemia that require continuous treatment. However, manypeople with these conditions go untreated or discontinue theirtreatment due to the burden of hospital visits and lack of subjective
symptoms. For example, a survey of people with diabetes＊4 hasrevealed that nearly 60% of both males and females in their 40s
are either untreated or have discontinued their treatment. The
use of telemedicine is increasing because it reduces the burden ofvisiting the hospital and makes it easier for patients to continue
receiving the treatment they need.
3.2 P sychiatry and psychosomatic medicine: Depression,
panic disorders, etc.
Telemedicine is used in psychiatry and psychosomatic

medicine to treat conditions such as depression, panic disorder,
alcohol-related disorders, and insomnia. In this field, many people
discontinue treatment due to the psychological and social hurdlesof going to medical institutions, and the difficulty of leaving thehouse. Telemedicine is used in this field because it makes it easierfor patients to continue receiving medical treatment as they can see
a doctor in a familiar environment such as their own home.
3.3 Pediatrics: Pediatric asthma and autism
Telemedicine is also used in pediatrics involving the treatmentof neurodevelopmental disorders such as autism and ADHD,
pediatric asthma, and intractable pediatric diseases. The parentsof a young child often find it difficult to take him/her to hospital,
especially if they also have other young children. In addition,
patients with intractable pediatric diseases often have to travela long distance for treatment due to the degree of specialization
required, and they shoulder a significant burden of arranging
travel and lodging for long-term regular visits. For this reason,
telemedicine, which allows patients to be seen from their own
home or some other location, is considered to be well suited tothis field. Another benefit of online consultation is that it provides
doctors with access to information such as the child’s homeenvironment that is not available when people visit them in person.
3.4 Allergic diseases: Pollinosis, atopic dermatitis, etc.
Many allergic diseases are compatible with telemedicine,as the patients are often young and have stable symptoms.
Telemedicine is used for many allergic diseases such as asthma,pollinosis and atopic dermatitis.
It is also used in the field of obstetrics and gynecology for
explaining the results of fertility tests and for conditions such as
dysmenorrhea that require regular visits. In this way, telemedicine
is used in a wide range of medical departments, and can becombined with face-to-face care in various ways according to the■ Figure 2: Breakdown of CLINICS medical examinations by clinical department(based on insurance records)＊3 Medley Inc. survey (June 2020)＊4 Source: 2012 National Health and Nutrition Survey, Ministry of Health, Labor and Welfare

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needs of patients and the strengths of medical institutions.

4. Specialist online second opinions andcoronavirus outpatient clinics
4.1 Online second opinions
CLINICS is also used by medical specialists as a means ofproviding second opinions in their specific fields. It allows patientsand their families to connect online with specialists via personal
computers and smartphones from anywhere in the country, andis therefore expected to alleviate the burden of traveling when
receiving a second opinion. The use of CLINICS is currently
spreading in university hospitals and core hospitals nationwide. At
the University of Tokyo Hospital, this system is now being used
to provide online second opinions among 26 clinical departments.
CLINICS is also being used to provide online second opinions invarious fields such as epilepsy and lung transplantation at Tohoku
University Hospital, and heart and aortic diseases at Kurashiki
Central Hospital.
■ Figure 3: Some of the medical institutions that use
CLINICS to provide online second opinions

4.2 Online Fever Outpatient Clinics
During the current pandemic, CLINICS is also being used
to operate “Online Fever Outpatient Clinics” so that an initial
treatment can be provided without coming into contact withpatients with cold-related symptoms including fever.
The pandemic has led to deregulation regarding the provisionof telemedicine. According to a communique from the Ministryof Health, Labor and Welfare on April 10, 2020, the provision of
medical care via telephones and other electronic communicationequipment has been sanctioned on a time-limited basis without
restrictions of facility requirements or diseases. In fact, as shownin Figure 4, more than 70% of medical institutions feel thattelemedicine is an effective way of preventing hospital-acquired
infections during the coronavirus pandemic.
Last winter, the system was also used as an Online Fever
Outpatient Clinic with the main purpose of dividing the flow of＊5 Source: 2018 Survey of Health Promotion for Working Women, Health and Global Policy Institute＊6 Source: Contraceptive Use by Method 2019, United Nation

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patients with fever and/or cold symptoms. This makes it possible
for medical institutions to provide patients for whom SARSCoV2 infection cannot be ruled out with initial treatment without
coming into direct contact with them.
■ Figure 4: Some of the medical institutions that use
CLINICS to provide online second opinions

5. Active collaboration with industry,government and academia
5.1 Telemedicine demonstration project in Yonaguni
During the project, CLINICS was used to provide
telemedicine for all the inhabitants of Yonaguni island in Okinawa
prefecture.
The island’s only medical institution is the chronicallyunderstaffed Yonaguni town clinic, where a single doctor has
to provide care to approximately 1,700 islanders (about 700
patients per month). If any medical personnel become infectedwith SARS-COV-2 under these circumstances, it will become
impossible to provide the medical care required by the islanders.
It was also found that patients tended to refrain from seeking
medical attention due to anxiety about the risk of infection.
Yonaguni town and its medical clinic therefore sought to maintainthe island’s medical system and address the issue of islanders who
refrain from visiting the doctor by building a system whereby
patients could receive online medical care via CLINICS if they
developed a fever.
5.2 O RBIS and Dai-ichi Life use CLINICS to address
menstruation issues
Although there is data showing that 45% of womenexperience menstrual problems that they are unable to cope withsuccessfully＊5, they tend not to have these problems treated forvarious reasons, such as assessing their own symptoms to be
not sufficiently serious, being unable to find the time to visit ahospital, or being hesitant to visit to a gynecologist. There is also
data showing that contraceptive pills are only used by 2.9% ofJapanese women, which is much lower than the average rate of
16.5% in developed countries＊6. One reason for this disparity isthought to be a lack of proper knowledge about non-contraceptive
uses of the pill, which is incorrectly regarded as having no otherpurpose besides birth control. Therefore, as part of measures tosupport the active participation of female employees, CLINICS isbeing increasingly used by businesses in order to raise awareness ofthe correct facts about menstruation and contraceptive pills, and to
alleviate the burden of female workers seeking medical attention.
ORBIS Inc. has started using this system to target approximately
1,000 female employees at its head office and shops, and the Daiichi Life Insurance Company, Ltd. has started using it to target
about 2,000 female employees working in the Tokyo metropolitan
area.

guidance, online prescription requests, and cashless payments.
By cooperating with the CLINICS telemedicine system, thismade it possible for patients to enjoy a complete online medicalexperience from online treatment to online medication guidance
via a single smartphone app. As of the end of March 2021, thissystem has so far been introduced at more than 3,800 pharmacies,
including every branch of pharmacy chain companies such as
Qol Holdings Co., Ltd., Kraft Co., Tanpopo Pharmacy Co., andNihon Chouzai Co., Ltd.

5.3 Free online mental health consultation for pregnant andpostpartum women
In partnership with the Saitama Obstetrics & Gynecology
Association, Medley, Inc. is utilizing CLINICS as a means ofproviding care and free online consultation to expectant andnursing mothers with regard to SARS-COV-2. Since May 2020,
this service has been operating at seven medical institutionsin Saitama prefecture, including Saitama Medical University
Hospital. This initiative was started not only because of thepossibility that pregnant and postpartum women were not being
provided with adequate mental health care during the coronavirus
pandemic, but also because they harbored strong feelings ofanxiety regarding pregnancy, childbirth and childcare, andbecause of the limited availability of medical staff familiar withmental health needs in the field of obstetrics and gynecology.

6.2 Electronic prescription development
Medley has also developed an electronic prescription
management system based on the FHIR, next-generation medical
information standard, for a project entrusted by the Ministry of
Health, Labor and Welfare to demonstrate the provision of a fullscale electronic prescription service. The system, which ran from2018 to 2019, enabled the examination of specific mechanisms tofacilitate the implementation of electronic prescriptions.

6. Online medication guidance and electronicprescription initiatives
6.1 Family pharmacy support system that facilitates online
medication guidance
In response to rules allowing the provision of online
medication guidance from September 2020, Medley Inc. haslaunched a family pharmacy support system called Pharms.
This system supports functions such as online medication

7. Conclusion
The government and other stakeholders are engaged in diverse
discussions related to telemedicine. At a meeting of the Regulatory
Reform Promotion Council in December 2020, Prime Minister
Suga declared his intention to extend the existing exceptional
measures permitting the provision of telemedicine and online
medication guidance, and to ensure that there would be no
reduction of standards compared to what is currently available.
For this reason, the future design of these services is being closelywatched.
At Medley Inc., we aim to improve the provision of medicalcare for both medical institutions and patients by making useof the know-how accumulated through over 300,000 medical
examinations.

■ Figure 5: A “one-stop” online medical experience

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